Randomized biopsy of the cervix is indicated whenever
a gross lesion of the cervix is seen. All too often, gross lesions
are diagnosed on sight as cervical "erosions or eversions" without
histologic confirmation. The Papanicolaou smear alone is not sufficient
for diagnosing gross lesions of the cervix.

The purpose of the operation
is to obtain a histologic specimen of the squamocolumnar junction of
the cervix.

Physiologic Changes. None.

Points of Caution. Cervical carcinoma
begins at the squamocolumnar junction. Therefore, it is essential that
this junction to be taken in any biopsy of the cervix.

This operation
has been illustrated in conjunction with Dilatation and
Curettage.

Technique

The cervix is exposed and immersed
in Schiller's iodine solution. The iodine solution will rapidly
stain cells storing glycogen. Those cells with rapid nuclei division
are generally glycogen depleted and therefore will not stain
with the iodine solution. These areas are known as "Schiller
white areas."

A sharp alligator-mouth biopsy
forceps is placed at the junction of the Schiller dark and Schiller
white areas; a liberal biopsy is obtained. This process is repeated
in at least four other quadrants. Rarely is cauterization or
suture of the biopsy site needed. A vaginal tampon is applied
to the cervix to absorb the cervical bleeding. If hemostasis
is required, a 4-0 synthetic absorbable suture or Avitene collagen
hemostat can be applied to the cervix.